Serious Occurrences in the Natural History of Advanced Climatic Keratopathy

Background: Climatic or chronic actinic keratopathy is an important corneal degeneration occurring after prolonged climatic exposure. The advanced stages of disease are confined generally to tropical or arid localities (including the Arctic) with high levels of sunlight. After many years of disease evolution, the advent of stage 3 keratopathy often presages a rapid downhill course. The instability of advanced climatic keratopathy has received little attention. Methods: Eighteen patients with advanced climatic keratopathy are described from the Transvaal region in South Africa and from Saudi Arabia. Patients with rapid disease progression, spontaneous sterile ulceration, and secondary microbial keratitis are described. Results: The rapid progression characteristic of stage 3 climatic keratopathy is illustrated. Severe, focal, sterile ulceration of the devitalized corneal degeneration may be common. Secondary infection may occur, leading to rapid dissolution of the climatic keratopathy material. Corneal perforation may ensue. The occurrence of yellow or brown fragments of the climatic keratopathy within or adjacent to the corneal inflammatory infiltrate indicates the predisposing cause of the infection, as usually also with examination of the opposite eye. Conclusions: These observations emphasize the inherent instability of advanced climatic keratopathy, which frequently takes a relentless downhill course. In rural populations of the developing world, climatic keratopathy is an important cause of blindness. Disease pathogenesis, treatment, and prevention deserve greater study. © 1994, American Academy of Ophthalmology, Inc. All rights reserved.